Where are we?

Question: Where are we? 

Anthony Fauci: Well the big issues are the whole issue of global peace. I think that’s one of the most important thing. I’m a scientist and a physician, and that’s not my area; but it just seems to me that the destruction, and the death, and the threat, and the insecurity that goes along with people who are ideologically at such odds that it leads to destruction, and death, and killing. To me, that is a major issue.

I’m sure there will always be wars; but I think we need to try as best as we can to understand what it is about people who are such at odds with us that they wish us harm; as well as analyze are we doing anything ourselves that are putting us at such odds with other people that we’re instigating this clash of cultures.

It’s no news to anybody. You just pick up the newspaper any day, you see another example of conflict throughout the world. And that’s something that we’ve got to pay a lot of attention to and do what we can, be it the Middle East problems, or the Israel-Palestine, Iraq-Iran, other nations. The Cold War which then warmed up, which is now getting back to a cold war. It’s kind of discouraging. 

Well actually bioethics is a very, very important field. As we get more and more in the arena of understanding science and getting better opportunities, the fact that you can do things with biological sciences that have an impact on a human being means you must have ethical standards. And paramount among these are when you do something that involves a human subject.

There are a lot of bioethical issues, but for example, if you’re trying to develop a new drug or a new vaccine, and you need to do experimentation, there has to be some fundamental, immutable principles of ethics that guide what you can and cannot do when you’re dealing with another human being. And there are also fundamental things that you can and cannot do when you’re dealing with life itself.

Is it or is it not ethical to create an embryo, and to create a person for the purpose of getting an organ to give to someone else? Your knee-jerk reaction is absolutely not; but you need the ethical analysis of that to show why and how that is something that you need to stay away from.

I think that bioethics is one of the most important, evolving fields that we have. Because, as science gets more and more sophisticated, and as the opportunities for transforming biological sciences occur, we’re going to be faced with more and more important ethical questions. And we can’t approach that by the seat of our pants. We have to have experts who study that and make that a career of analyzing the kinds of ethical issues and gaining experience so that when people come in, and they’re faced with a question of ethics in the biological sciences, at least you have a cadger of people who pay serious attention to that.

Well the important issues in global health are the fact that there are situations in the world where people are dying from diseases that are imminently preventable if we do the right public health measures. That is complicated, and this is one of the reasons why I find public health, in many respects, so invigorating and exciting. Because if it was just public health in a vacuum, it would be relatively easy. But it’s public health intertwined with poverty, disenfranchisement, wars, lack of leadership, environmental cataclysmic issues like tsunamis and earthquakes, and things like that. 

We’re living in a world where, if you’re in the United States or in the U.K. or Canada, there are diseases that you don’t even think about because they don’t have any impact. You’re vaccinated against them. If you get sick, you get an antibiotic. The environment is not threatening, like malarias and mosquitoes and things like that.

Then you go into Sub Saharan Africa and you see things that are unthinkable – 1.3 million people dying every year of malaria, more than a million of which are less than five years old, many of which are less than one year old; one point six million people dying of tuberculosis; ______ diseases and respiratory diseases ravishing populations. These are things that can be prevented.

So to me, one of the most challenging issues that I look at when you talk about global issues and global health is obviously, it isn’t as easy as just bringing medications there. You’ve got to do it at the same time as you build a sustainable infrastructure in the countries involved so that they can ultimately fend for themselves. Going in, treating people for malaria, giving them bed nets, spraying their huts, etc., that’s all good, and that will decrease the whole issue of malaria in certain countries. But what we’ve got to do at the same time is to build what we call a sustainable infrastructure to help the world to get on a much, much more even keel with the developed world; and to prevent literally millions and millions of deaths each year.

To me, that’s the big challenge.

To me, it isn’t easy; but to me, it seems to be easy. And that is to adopt a policy of health diplomacy.

In fact, Governor Tommy Thompson spoke about this just this morning [July 6, 2007], here in Aspen. And that is to make as an important goal that the United States and other developed countries will export global health; will help people in countries who have situations that they cannot handle – vis-à-vis health – but also to help them to build the infrastructure that they will need to sustain it on their own.

And that’s helping to train physicians and healthcare providers; making the incentive for them to stay in their own countries, or return to their own countries after they train here in the United States; help them to do the very simple things like vaccinations and prevention of malaria by simple things like bed nets.

Those are the kinds of things that we need to do. If we engage and put a fraction of the resources that we put into other areas that we put into global health diplomacy, I think not only would it be good for the rest of the world, but the United States will be looked upon in a much more favorable light than it is currently [i.e. 2007] looked upon.

Well I think his [George W. Bush] legacy in health will be very, very positive when it comes to international, global health. I think the combination of the President’s Emergency Plan for AIDS Relief – the PEPFAR Program – and the President’s Malaria Initiative – the PMI – those two things alone, I think, from a health standpoint and from global recognition in the arena of health, will be, in my opinion, the most important, and lasting, and positive legacy of this administration.

Well first of all, for domestic health, the issue that’s crying out to be addressed, and it’s going to take courage on the part of leadership, the President, it’s going to take cooperation with the Congress; it’s going to take an understanding and a flexibility on the part of the American public; is that we must address the fact that in this rich country of ours, we have 40-plus million people without healthcare insurance.

So we’ve got to be able to fix that problem, and fix it reasonably quickly so that when people lose their jobs, and with it lose their health insurance, and find out that they’re one job dismissal away from being completely vulnerable to disease and getting their savings and their family wiped out because they don’t have health insurance--we’ve got to fix that problem.

So if you’re asking me what I would think if the next president were to ask me my opinion, and what I would think from a domestic standpoint what we need to do, we really need to fix the healthcare delivery problem in this country [USA] with regard to universal health access to everyone. It’s not going to be easy, but I think it can be done. I think that if you have a flexible system where people can still have the choice of the doctor that they want, if they have insurance that they are able to pay for.

But that doesn’t mean that you then not allow people who don’t have the wherewithal to have insurance, that everybody has insurance.

And everybody can get a doctor. It may not necessarily be the doctor of your choice, but it’s a doctor that’s well trained and paid well enough to be someone of high quality. So just because you go into a system where you’re assigned a doctor, if you have people who are well trained and well paid, and have good motivations for being in that, you can get good medical care.

You don’t necessarily have to then exclude those people who want to choose their own doctor, and are willing to pay to choose their own doctor. So I think you can get both worlds there.

And also, there’s enough profit margin in drugs and the development of drugs that I don’t think there’s going to be an issue with the drug companies. There’s always going to be the need for new medications, better medications. So I don’t see that as an issue.

Disease in this country, we still have a problem with HIV/AIDS. Right now there are still 40,000 new infections each year in our nation. That has plateaued at 40,000 for the last 14 years. That’s disgraceful. We’ve got to do something about that.

And the CDC [Centers for Disease Control and Prevention] is already going in that direction by making testing for HIV a part of routine healthcare. 

There are a million people who are infected in this country with HIV, at least 25% of which do not know that they are infected. And the much greater majority of those people are the ones that are inadvertently transmitting the infection to others. So we’ve got to get and break that wall, and push down that wall of 40,000 new infections each year from the standpoint of health in this country. That’s, to me, the first thing that we need to do.

Bio-terrorism is a threat. It’s very, very difficult when you have to prepare for something that might not ever happen. So I have been very much involved in the preparedness for bio-defense by developing vaccines, therapeutics, diagnostics for the category A and B agents that are the highest calculated risk by our Homeland Security officials.

And what we’ve done, to try and make that a worthwhile endeavor, is as follows: to use the resources that you would apply to developing these vaccines, and these drugs, and these diagnostics to not only cover infections or microbes that would be deliberately released on the country, but also the broader bio-terrorist. The worst potential bio-terrorist is nature itself.

If you look historically at what’s happened with epidemics, and the influenza pandemic in 1918, the threat of SARS [severe acute respiratory syndrome], the HIV epidemic. So nature does a pretty good job of terrorizing the human civilization.

So if you utilize the resources that you can apply to developing specific countermeasures for agents of high probability of bio-terror, but make that be fungible, as it were, to increasing your capacity to respond to any agent, even those that naturally occur.

So yes it’s a threat. You can never quantitate how great a threat it is. So why not spend the money not only protecting against the threat of deliberate terror, but also the threat of naturally occurring terror?

There is comfort in that literally, as the weeks and months go by, our preparedness against this gets better and better. There certainly is the possibility that there will be a bio-terror attack. If you’re well prepared and you have the counter measures in place, the impact on people will hopefully be minimal.

I don’t think that people need to look upon this as the end of the world, where we would have a bio-terror attack and we all die. The chances of that are so vanishingly small as to be almost not under consideration; but there is the possibility that people could die or get sick from a bio-terror attack. You can mitigate that.  You can lessen the impact of it by doing what we’re literally doing every week and month now. And that is by trying to develop better countermeasures.

 

Recorded On: July 6, 2007

Fauci argues for an organized approach to bioethics, and to the fight against disease in the developing world.

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Freud is renowned, but his ideas are ill-substantiated

The Oedipal complex, repressed memories, penis envy? Sigmund Freud's ideas are far-reaching, but few have withstood the onslaught of empirical evidence.

Mind & Brain
  • Sigmund Freud stands alongside Charles Darwin and Albert Einstein as one of history's best-known scientists.
  • Despite his claim of creating a new science, Freud's psychoanalysis is unfalsifiable and based on scant empirical evidence.
  • Studies continue to show that Freud's ideas are unfounded, and Freud has come under scrutiny for fabricating his most famous case studies.

Few thinkers are as celebrated as Sigmund Freud, a figure as well-known as Charles Darwin and Albert Einstein. Neurologist and the founder of psychoanalysis, Freud's ideas didn't simply shift the paradigms in academia and psychotherapy. They indelibly disseminated into our cultural consciousness. Ideas like transference, repression, the unconscious iceberg, and the superego are ubiquitous in today's popular discourse.

Despite this renown, Freud's ideas have proven to be ill-substantiated. Worse, it is now believed that Freud himself may have fabricated many of his results, opportunistically disregarding evidence with the conscious aim of promoting preferred beliefs.

"[Freud] really didn't test his ideas," Harold Takooshian, professor of psychology at Fordham University, told ATI. "He was just very persuasive. He said things no one said before, and said them in such a way that people actually moved from their homes to Vienna and study with him."

Unlike Darwin and Einstein, Freud's brand of psychology presents the impression of a scientific endeavor but ultimately lack two of vital scientific components: falsification and empirical evidence.

Psychoanalysis

Freud's therapeutic approach may be unfounded, but at least it was more humane than other therapies of the day. In 1903, this patient is being treated in "auto-conduction cage" as a part of his electrotherapy. (Photo: Wikimedia Commons)

The discipline of psychotherapy is arguably Freud's greatest contribution to psychology. In the post-World War II era, psychoanalysis spread through Western academia, influencing not only psychotherapy but even fields such as literary criticism in profound ways.

The aim of psychoanalysis is to treat mental disorders housed in the patient's psyche. Proponents believe that such conflicts arise between conscious thoughts and unconscious drives and manifest as dreams, blunders, anxiety, depression, or neurosis. To help, therapists attempt to unearth unconscious desires that have been blocked by the mind's defense mechanisms. By raising repressed emotions and memories to the conscious fore, the therapist can liberate and help the patient heal.

That's the idea at least, but the psychoanalytic technique stands on shaky empirical ground. Data leans heavily on a therapist's arbitrary interpretations, offering no safe guards against presuppositions and implicit biases. And the free association method offers not buttress to the idea of unconscious motivation.

Don't get us wrong. Patients have improved and even claimed to be cured thanks to psychoanalytic therapy. However, the lack of methodological rigor means the division between effective treatment and placebo effect is ill-defined.

Repressed memories

Sigmund Freud, circa 1921. (Photo: Wikimedia Commons)

Nor has Freud's concept of repressed memories held up. Many papers and articles have been written to dispel the confusion surrounding repressed (aka dissociated) memories. Their arguments center on two facts of the mind neurologists have become better acquainted with since Freud's day.

First, our memories are malleable, not perfect recordings of events stored on a biological hard drive. People forget things. Childhood memories fade or are revised to suit a preferred narrative. We recall blurry gists rather than clean, sharp images. Physical changes to the brain can result in loss of memory. These realities of our mental slipperiness can easily be misinterpreted under Freud's model as repression of trauma.

Second, people who face trauma and abuse often remember it. The release of stress hormones imprints the experience, strengthening neural connections and rendering it difficult to forget. It's one of the reasons victims continue to suffer long after. As the American Psychological Association points out, there is "little or no empirical support" for dissociated memory theory, and potential occurrences are a rarity, not the norm.

More worryingly, there is evidence that people are vulnerable to constructing false memories (aka pseudomemories). A 1996 study found it could use suggestion to make one-fifth of participants believe in a fictitious childhood memory in which they were lost in a mall. And a 2007 study found that a therapy-based recollection of childhood abuse "was less likely to be corroborated by other evidence than when the memories came without help."

This has led many to wonder if the expectations of psychoanalytic therapy may inadvertently become a self-fulfilling prophecy with some patients.

"The use of various dubious techniques by therapists and counselors aimed at recovering allegedly repressed memories of [trauma] can often produce detailed and horrific false memories," writes Chris French, a professor of psychology at Goldsmiths, University of London. "In fact, there is a consensus among scientists studying memory that traumatic events are more likely to be remembered than forgotten, often leading to post-traumatic stress disorder."

The Oedipal complex

The Blind Oedipus Commending His Children to the Gods by Benigne Gagneraux. (Photo: Wikimedia Commons)

During the phallic stage, children develop fierce erotic feelings for their opposite-sex parent. This desire, in turn, leads them to hate their same-sex parent. Boys wish to replace their father and possess their mother; girls become jealous of their mothers and desire their fathers. Since they can do neither, they repress those feelings for fear of reprisal. If unresolved, the complex can result in neurosis later in life.

That's the Oedipal complex in a nutshell. You'd think such a counterintuitive theory would require strong evidence to back it up, but that isn't the case.

Studies claiming to prove the Oedipal complex look to positive sexual imprinting — that is, the phenomenon in which people choose partners with physical characteristics matching their same-sex parent. For example, a man's wife and mother have the same eye color, or woman's husband and father sport a similar nose.

But such studies don't often show strong correlation. One study reporting "a correction of 92.8 percent between the relative jaw width of a man's mother and that of [his] mates" had to be retracted for factual errors and incorrect analysis. Studies showing causation seem absent from the literature, and as we'll see, the veracity of Freud's own case studies supporting the complex is openly questioned today.

Better supported, yet still hypothetical, is the Westermarck effect. Also called reverse sexual imprinting, the effect predicts that people develop a sexual aversion to those they grow up in close proximity with, as a mean to avoid inbreeding. The effect isn't just shown in parents and siblings; even step-siblings will grow sexual averse to each other if they grow up from early childhood.

An analysis published in Behavioral Ecology and Sociobiology evaluated the literature on human mate choice. The analysis found little evidence for positive imprinting, citing study design flaws and an unwillingness of researchers to seek alternative explanations. In contrast, it found better support for negative sexual imprinting, though it did note the need for further research.

The Freudian slip

Mark notices Deborah enter the office whistling an upbeat tune. He turns to his coworker to say, "Deborah's pretty cheery this morning," but accidentally blunders, "Deborah's pretty cherry this morning." Simple slip up? Not according to Freud, who would label this a parapraxis. Today, it's colloquially known as a "Freudian slip."

"Almost invariably I discover a disturbing influence from something outside of the intended speech," Freud wrote in The Psychopathology of Everyday Life. "The disturbing element is a single unconscious thought, which comes to light through the special blunder."

In the Freudian view, Mark's mistaken word choice resulted from his unconscious desire for Deborah, as evident by the sexually-charged meanings of the word "cherry." But Rob Hartsuiker, a psycholinguist from Ghent University, says that such inferences miss the mark by ignoring how our brains process language.

According to Hartsuiker, our brains organize words by similarity and meaning. First, we must select the word in that network and then process the word's sounds. In this interplay, all sorts of conditions can prevent us from grasping the proper phonemes: inattention, sleepiness, recent activation, and even age. In a study co-authored by Hartsuiker, brain scans showed our minds can recognize and correct for taboo utterances internally.

"This is very typical, and it's also something Freud rather ignored," Hartsuiker told BBC. He added that evidence for true Freudian slips is scant.

Freud's case studies

Sergej Pankejeff, known as the "Wolf Man" in Freud's case study, claimed that Freud's analysis of his condition was "propaganda."

It's worth noting that there is much debate as to the extent that Freud falsified his own case studies. One famous example is the case of the "Wolf Man," real name Sergej Pankejeff. During their sessions, Pankejeff told Freud about a dream in which he was lying in bed and saw white wolves through an open window. Freud interpreted the dream as the manifestation of a repressed trauma. Specifically, he claimed that Pankejeff must have witnessed his parents in coitus.

For Freud this was case closed. He claimed Pankejeff successfully cured and his case as evidence for psychoanalysis's merit. Pankejeff disagreed. He found Freud's interpretation implausible and said that Freud's handling of his story was "propaganda." He remained in therapy on and off for over 60 years.

Many of Freud's other case studies, such "Dora" and "the Rat Man" cases, have come under similar scrutiny.

Sigmund Freud and his legacy

Freud's ideas may not live up to scientific inquiry, but their long shelf-life in film, literature, and criticism has created some fun readings of popular stories. Sometimes a face is just a face, but that face is a murderous phallic symbol. (Photo: Flickr)

Of course, there are many ideas we've left out. Homosexuality originating from arrested sexual development in anal phase? No way. Freudian psychosexual development theory? Unfalsifiable. Women's penis envy? Unfounded and insulting. Men's castration anxiety? Not in the way Freud meant it.

If Freud's legacy is so ill-informed, so unfounded, how did he and his cigars cast such a long shadow over the 20th century? Because there was nothing better to offer at the time.

When Freud came onto the scene, neurology was engaged in a giddy free-for-all. As New Yorker writer Louis Menand points out, the era's treatments included hypnosis, cocaine, hydrotherapy, female castration, and institutionalization. By contemporary standards, it was a horror show (as evident by these "treatments" featuring so prominently in our horror movies).

Psychoanalysis offered a comparably clement and humane alternative. "Freud's theories were like a flashlight in a candle factory," anthropologist Tanya Luhrmann told Menand.

But Freud and his advocates triumph his techniques as a science, and this is wrong. The empirical evidence for his ideas is limited and arbitrary, and his conclusions are unfalsifiable. The theory that explains every possible outcome explains none of them.

With that said, one might consider Freud's ideas to be a proto-science. As astrology heralded astronomy, and alchemy preceded chemistry, so to did Freud's psychoanalysis popularize psychology, paving the way for its more rapid development as a scientific discipline. But like astrology and alchemy, we should recognize Freud's ideas as the historic artifacts they are.

Why are so many objects in space shaped like discs?

It's one of the most consistent patterns in the unviverse. What causes it?

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  • Spinning discs are the result of two things: The force of gravity and a phenomenon in physics called the conservation of angular momentum.
  • Gravity brings matter together; the closer the matter gets, the more it accelerates – much like an ice skater who spins faster and faster the closer their arms get to their body. Then, this spinning cloud collapses due to up and down and diagonal collisions that cancel each other out until the only motion they have in common is the spin – and voila: A flat disc.